At last reading, the administration's national health care reform proposals contained not one reference to social work. It appears that the National Association of Social Workers (NASW) had substantial impact on framing the provisions to include universal coverage, substance abuse and mental health benefits, and reimbursement of nonphysician providers. Nevertheless, when the proposals were sent to Capitol Hill, they did not include any specific reference to social workers as essential health care providers. Administration officials reportedly said this was an oversight.
Why would this omission of social work matter? First, if there is not necessarily a need for social workers in health care--the sector that employs more social workers than any other--then there will not necessarily be reimbursement for social work services, and there will not necessarily be jobs.
Second, if there is not necessarily a need for social workers, there will not be federal training dollars. It is those dollars that ensure access to education for people of varied race and ethnicity and from disadvantaged backgrounds.
Third, if there is not necessarily a need for social workers, there is not likely to be a need for the social work perspective in health research. So much for the recent promise to increase social work research support at the federal level.
Finally and foremost, if there is not necessarily a need for social workers in health care, there is not necessarily going to be health care, as contrasted with medical care. There is not necessarily going to be outreach that goes beyond a poster or a mailing, nor assessments that inquire what clients themselves believe is wrong or "what needs fixing" to maintain their health (Pinderhughes, 1989). If social work employment or education or research or service programs matter to social workers, then health care reform legislation matters. Moreover, health care reform is only one prominent example of the fundamental difference that federal legislation makes on a professional as well as a very personal level. The omission of social work in health care reform is likely to be corrected through the vigorous legislative action of NASW. This situation, however, demonstrates how important vigorous action is.
Since social work's beginnings, social workers have attempted to influence the political process (Brieland, 1982; Ginsberg, 1988; Wolk, 1981). Nevertheless, virtually all articles on social work and politics admonish social workers to give more precedence to political activity. Abraham Ribicoff, then Secretary of Health, Education, and Welfare, wrote in 1962, "Social workers have been inconspicuous for much too long around the committee rooms, state legislatures, and halls of Congress. . . . You have not wielded your influence to anywhere near the degree your unique fund of knowledge and your skill at working with people might warrant".
Authors on the topic of legislative advocacy--lobbying--frequently find it necessary to adopt a tone of persuasion toward fellow social workers. If these authors have diagnosed the situation correctly, some social workers need to be convinced that lobbying is desirable and necessary. Haynes and Mickelson (1986), for example, stated, "It is our contention that lobbying is a legitimate, fundamental, and powerful practice in a pluralistic society, and that social workers and their clients will continue to lose politically if they do not enter the arena. . . . Because our political structure is both representative and pluralistic, it requires and even demands that some individuals speak on behalf of others". Mahaffey (1972), in a classic article on lobbying and social work, sought to enlarge social workers' views of the critical importance of engaging in the political process "to expand social and rehabilitation services for those who are powerless, discriminated against, shackled by circumstances, and deprived of opportunities to achieve their maximum individual potential". …